In recent years, with the continuous improvement of the level of medical insurance reimbursement, the gradual expansion of the scope of drugs in the medical insurance catalog, especially the steady progress of the reform of employee medical insurance outpatient mutual aid security, it is more convenient for the people to buy drugs and drugs, and hospitals, pharmacies, clinics, and even online can purchase drugs and be reimbursed by medical insurance. However, while the policy of benefiting the people brings benefits and convenience to the whole people, it also makes some criminals think crookedly, and many drug dealers induce the insured to participate in drug trading through "high-price recycling". This kind of disguised recovery of the drugs purchased by the insured after enjoying the reimbursement of medical insurance, and reselling them in a different guise, is the "reflux drug" of medical insurance.
What are the dangers of "reflux drugs"?
First, "fake medicines" are harmful to people. Some drug dealers sell real drugs to small clinics with scattered medicines, and then fill the real medicine boxes with fake drugs and sell them to pharmacies, so that if patients accidentally take them, not only will the treatment effect be affected, but also more likely to endanger their lives.
The second is that "expired medicine" misleads people. Because the expiration date of drugs is not directly printed on the tablets, many drug dealers remove expired or expired drugs from their original packaging and put them into new boxes. Patients can only see the new date on the new medicine box, and do not know that they are taking expired medicine.
The third is the "wrong medicine" killing. In the process of dismantling and reassembling "reflux drugs", some drug dealers often have confusion about the dosage specifications and drug types. Children who take adult drugs can be life-threatening, patients who need to promote blood circulation can die directly after taking coagulation drugs, and some special drugs for mental anesthesia and analgesia are even resold as drugs to young children who pursue novelty......
Huang from Longyan, Fujian Province, became addicted to drugs but had no income, and embarked on the road of "selling and smoking" in order to take drugs. She repeatedly sold tramadol hydrochloride, federal cough lotion, and Aoting cough drops to school students and young people in society for huge profits by mailing, direct delivery, and direct peddling at her rented residence, and was later arrested by the public security organs.
Fourth, "cheating insurance" traps people. Obtaining drugs through over-dispensing, repeated dispensing, etc., and then reselling them to drug dealers, this is fraud and insurance fraud.
In 2020, the Medical Insurance Bureau of Jinhua City, Zhejiang Province, through big data analysis, found that the medical insurance data of Hu Mouliang, a hemophilia patient, was abnormal. Hu Mouliang was finally sentenced to 10 years and six months, and his wife knew that he had committed a crime, but still assisted him in prescribing and sending medicine, and could not escape legal punishment.
The existence of "reflux drugs" has made the whole society have to pay a price. Doctors do not dare to prescribe a large number of medicines, the packaging volume of drugs is getting smaller and smaller, the market order of normal purchase and sale is seriously disrupted, and the medical insurance fund that should be used to save lives is constantly "gnawed" by a small number of lawbreakers.
What are the consequences of participating in "reflux drugs"?
Direct sales and indirect auxiliary sales of "reflux drugs" are all acts of fraud and insurance fraud. According to Article 41 of the Regulations on the Supervision and Administration of the Use of Medical Security Funds, if an individual takes advantage of the opportunity to enjoy medical security benefits to resell drugs, accept the return of cash, goods or obtain other illegal benefits for the purpose of defrauding the medical security fund, and causes losses to the medical insurance fund, the online settlement of medical expenses shall be suspended for 3 months to 12 months, and a fine of not less than 2 times but not more than 5 times the amount obtained by fraud shall be imposed. If the amount involved is large and the circumstances are serious, it will also constitute the crime of fraud.
In response to the "drug dealers", the national ministries and commissions have also struck hard. In February 2024, the Supreme People's Court, the Supreme People's Procuratorate, and the Ministry of Public Security jointly issued the "Guiding Opinions on Several Issues Concerning the Handling of Criminal Cases of Medical Insurance Fraud", which clearly points out that those who illegally purchase or sell drugs that they know are purchased through medical insurance fraud shall be convicted and punished for the crime of covering up or concealing criminal proceeds in accordance with the provisions of Article 312 of the Criminal Law and relevant judicial interpretations; Sales, in accordance with the provisions of Criminal Law article 266, are to be convicted and punished as the crime of fraud. At the recent press conference jointly held by the "two supremes and one department", a typical case of cracking down on the crime of "reflux drugs" insurance fraud was exposed. In this case, Ma Mouyu, a drug dealer, repeatedly used the medical insurance certificates of 11 people, including Zhao Moumou, to falsely seek medical treatment and purchase drugs in a number of hospitals in Beijing, and sold some of the drugs for profit, and was finally sentenced to eight years and three months in prison.
In April 2024, six departments, including the National Health Insurance Administration, the Supreme People's Court, the Supreme People's Procuratorate, the Ministry of Public Security, the Ministry of Finance, and the National Health Commission, jointly deployed the special rectification work on violations of laws and regulations in the medical insurance fund.
Through the intelligent monitoring of medical insurance big data, the medical insurance department will strengthen the screening and analysis of relevant suspicious issues, lock the clues of the problem in a timely manner, and achieve precise strikes. Moreover, the drugs prescribed by hospitals and medical insurance designated pharmacies have a code scanning record, and sooner or later, every box of drugs sold will become the most direct evidence of violations and crimes.
The National Health Insurance Administration reminds you to be vigilant, do not buy drugs from unknown sources and damaged packaging, and do not turn the "life-saving drugs" in your hands into a "cash cow" for drug dealers.
If you find similar fraud and insurance fraud, please call the national bureau to combat fraud and insurance fraud at 010-89061396 or 010-89061397, or report to the local medical insurance department in time. The medical insurance department will give a reward of up to 200,000 yuan depending on the report.
Source: Wuhai News